Palatal Tremor Revisited: Disorder with Nosological Diversity and Etiological Heterogeneity

Nagappa, Madhu; Bindu, Parayil Sankaran; Sinha, Sanjib; Bharath, Rose Dawn; Mangalore, Sandhya; Saini, Jitender; Mathuranath, P. S.; Taly, Arun B.

doi:10.1017/cjn.2017.273

Cited by 9 publications

(26 citation statements)

References 12 publications

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“…The rarer clinical features reported were optic atrophy, vertical gaze paresis, facial dyskinesia, seizure and encephalopathy. Ophthalmoplegia was observed more frequently in unilateral HOD while ocular myoclonus and generalised myoclonus was observed in patients with bilateral HOD [27]. Ear clicking is rare in SPT [28].…”

Section: Ii) Symptomatic Palatal Tremor (Table 2)mentioning

confidence: 94%

“…Causes of palatal tremor: ( EPT is idiopathic. SPT can occur due to any lesion in the dentato-rubro-olivary pathway of the GMT [1,[23][24][25][26][27][28]. The common causes of SPT are infarct (hemorrhagic or ischemic), tumour, vascular malformation, drugs and demyelination ( Table 1) [24][25][26][27][28].…”

Section: Pathogenesis Of Progressive Ataxia and Palatal Tremor (Papt)mentioning

confidence: 99%

“…PAPT shows the relentless progression of ataxia. Sporadic PAPT reveals abnormal eye findings (saccadic pursuit, pendular nystagmus), oscillopsia and progressive ataxia EPT can be distinguished from the SPT by the presence of an audible click, the variability of the tremors, the • Basilar artery occlusion [36] • Brainstem or cerebellar infarct/bleed/tumor • Vertebral artery dolichectasia [37] • Vascular malformation (Arteriovenous malformation, aneurysm) [24][25][26][27][28]38] II) Inflammatory/Demyelinating:…”

Section: Ii) Symptomatic Palatal Tremor (Table 2)mentioning

confidence: 99%

“…The HOD can be unilateral or bilateral (Figure 2) [24][25][26]. A bilateral HOD is more likely to be idiopathic [25][26][27]. Four different patterns of HOD were described in the literature based on the location of the primary lesion.…”

Section: Investigations (Table 4)mentioning

confidence: 99%

“…The LVP is supplied by the 9th and 10% th cranial nerves. SPT arises from a lesion within the Guillain Mollaret triangle (GMT) (Figure 1 ) [ 1 10 23 24 25 26 27 ]. The GMT is a conceptual triangle in the brainstem.…”

Section: Pathogenesis Of Symptomatic Palatal Tremor (Spt)mentioning

confidence: 99%

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Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Bhattacharjee

2020

Tremor and Other Hyperkinetic Movements

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Background: Palatal tremor is involuntary, rhythmic and oscillatory movement of the soft palate. Palatal tremor can be classified into three subtypes; essential, symptomatic and palatal tremor associated with progressive ataxia. Methods: A thorough Pubmed search was conducted to look for the original articles, reviews, letters to editor, case reports, and teaching neuroimages, with the keywords "essential", "symptomatic palatal tremor", "myoclonus", "ataxia", "hypertrophic", "olivary" and "degeneration". Results: Essential palatal tremor is due to contraction of the tensor veli palatini muscle, supplied by the 5 th cranial nerve. Symptomatic palatal tremor occurs due to the contraction of the levator veli palatini muscle, supplied by the 9 th and 10 th cranial nerves. Essential palatal tremor is idiopathic, while symptomatic palatal tremor occurs due to infarction, bleed or tumor within the Guillain-Mollaret triangle. Progressive ataxia and palatal tremor can be familial or idiopathic. Symptomatic palatal tremor and sporadic progressive ataxia with palatal tremor show signal changes in inferior olive of medulla in magnetic resonance imaging. The treatment options available for essential palatal tremor are clonazepam, lamotrigine, sodium valproate, flunarizine and botulinum toxin. The treatment of symptomatic palatal tremor involves the treatment of the underlying cause. Discussion: Further studies are required to understand the cause and pathophysiology of Essential palatal tremor and progressive ataxia and palatal tremor. Similarly, the link between tauopathy and palatal tremor associated progressive ataxia needs to be explored further. Oscillopsia and progressive ataxia are more debilitating than palatal tremor and needs new treatment approaches.

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Section: Ii) Symptomatic Palatal Tremor (Table 2)mentioning

confidence: 94%

Section: Pathogenesis Of Progressive Ataxia and Palatal Tremor (Papt)mentioning

confidence: 99%

Section: Ii) Symptomatic Palatal Tremor (Table 2)mentioning

confidence: 99%

Section: Investigations (Table 4)mentioning

confidence: 99%

Section: Pathogenesis Of Symptomatic Palatal Tremor (Spt)mentioning

confidence: 99%

See 3 more Smart Citations

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Bhattacharjee

2020

Tremor and Other Hyperkinetic Movements

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Clinical and Imaging Profile of Patients with Palatal Tremor

Surisetti

Prasad

Holla

et al. 2021

Movement Disord Clin Pract

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Background Palatal tremor (PT) is an uncommon movement disorder that may be classified into symptomatic (SPT) or essential (EPT). The etiology of SPT is varied, with involvement of the Guillain‐Mollaret triangle (GMT) and inferior olivary hypertrophy. EPT is associated with ear clicks and normal imaging and may have a functional basis. Objectives This study aims to explore the clinical and radiological features of a large cohort of patients with PT. Methods This is a retrospective chart review of patients with PT who were evaluated by the movement disorders subspeciality of the neurology department. Demographic, clinical, and imaging details of patients with PT were documented. Results A total of 22 patients with PT comprising 17 with SPT and 5 with EPT were included in this study. No patient was aware of the PT. Ear clicks were reported in 2 patients with SPT and in 3 patients with EPT. The most common etiology for SPT was vascular, followed by degenerative conditions. Patients with SPT had associated features such as tremor (70.6%), ataxia (64.7%), dystonia (52.9%), myoclonus (17.6%), and eye movement abnormalities (75%). Lesions involving the GMT were found in 82% of patients with SPT. Apart from PT, patients with EPT had no other motor symptoms, and imaging was normal. Of the patients with EPT, 2 had additional functional movement disorders. Conclusion PT has significant etiological heterogeneity and can be easily missed because of the lack of awareness by patients. Involvement of the inferior olivary nucleus may not be necessarily observed. A functional etiology should be considered in cases of EPT.

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The Guillain-Mollaret triangle: a key player in motor coordination and control with implications for neurological disorders

Ogut,

Armagan,

Tufekci

2023

Neurosurg Rev

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Palatal Tremor Revisited: Disorder with Nosological Diversity and Etiological Heterogeneity

Cited by 9 publications

References 12 publications

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Palatal Tremor – Pathophysiology, Clinical Features, Investigations, Management and Future Challenges

Clinical and Imaging Profile of Patients with Palatal Tremor

The Guillain-Mollaret triangle: a key player in motor coordination and control with implications for neurological disorders

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